Intestinal Ultrasound Transmural Healing Was Associated With Improved Long-Term Outcomes Among Patients With Endoscopic Remission: Results of a Prospective Study.

BACKGROUND

STRIDE II guidelines recognise endoscopic healing as a main therapeutic target in Crohn's disease (CD). Nevertheless, transmural healing (TH) could reduce the risk of long-term complications.

AIM: To assess the impact of intestinal ultrasound (IUS) TH on CD long-term among patients with endoscopic healing.

METHOD: We conducted a prospective study of consecutive patients with CD who underwent colonoscopy with endoscopic healing (CDEIS < 4) and IUS. IUS TH was defined by a bowel wall thickness < 3 mm without colour Doppler signal. The primary endpoint was CD relapse (drug intensification, initiation of steroid, CD-related hospitalization or surgery, luminal stricture/fistula or perianal CD).

RESULTS

We included 93 patients. IUS TH was observed in 73%. No difference in median IBD-risk score was observed among patients with and without IUS TH (22 (IQR 7-41) vs. 30 (IQR 13-55); p = 0.15). After a median follow-up of 22.5 months (IQR 19.3-23.7), the cumulative risk of relapse was significantly lower among patients with IUS healing (17% vs. 48%; p = 0.007). The benefit of TH remained when considering only patients with complete endoscopic healing (CDEIS = 0) (12-month relapse rate, 2% vs. 33%; p = 0.03). The risk of CD-related hospitalization (3% vs. 16%; p = 0.04) and perianal CD (3% vs. 16%; p = 0.04) were significantly lower among patients with IUS healing. In multivariate analysis, the absence of TH remained the only independent factor associated with CD relapse (hazard ratio 2.6 (1.1-6.2); p = 0.03).

CONCLUSION

IUS TH was associated with improved long-term outcomes with lower risks of CD relapse, hospitalization, and perianal CD.